Organizational models for occupational health services

Occupational health services for all workers, irrespective of age, sex, nationality, type of employment, size or location of workplace, has been a long-term objective of the World Health Organization. Few countries, if any, have lived up to this challenge completely. The development of occupational health services differs from country to country. Some countries have hardly any occupational health services at all; others provide highly developed services.

Occupational health services are organized in various ways in different countries. An important issue is that the OHS must be free and independent. The OHS must be neutral and not take side with any of the two parts of the working life, either the employer or the employee. The challenge is to determine how can this best be accomplished.

Two models

Two main types of occupational health services exist: One is called “internal occupational health service”. In internal OHS, personnel are employed by the individual companies. The second type is called “external occupational health service”, and involves personnel working in an external unit serving several companies.

Internal OHS

In internal occupational health services, the occupational health personnel usually are located on the company premises, and the personnel are employed by the company. This is a solution often chosen by large companies who can afford to employ their own personnel. This model of OHS makes it possible for OHS personnel to be close to the workers and their problems, and gives great opportunities for understanding the work processes as well as the company culture. However, the closeness to the company might make it difficult for OHS personnel to ask for changes; for instance, for improvement of the work environment. It is important that OHS units are able to to keep their integrity.

External OHS

Personnel in the external model are most often based in units outside the companies. There are different ways to organize such units. An external occupational health services can be owned by a number of companies that co-operate. These types of OHS can also be established as separate companies, owned by an outside owner, a hospital or privately (a joint-stock-company). They can also be owned by the health personnel themselves. An external type of OHS usually serves many companies, and is a good solution for smaller companies who cannot employ their own OHS staff. In this model of OHS, it is harder for the OHS personnel to be close to the workers and their problems, and a thorough understanding the work processes in the company might also be challenging. The external OHS unis often describe themselves as particularly independent, as they do not depend on the company they serve – directly. However, such units have to find customers. The customers are the companies. Discussions on the price of the service and how to attract clients are common among personnel in the external occupational health services, and competition between the units can be fierce in some countries. External OHS units can sometimes be large, giving opportunities for a good scientific environment, but can also be organized as a chain of smaller units where the personnel work much alone.

Who pays?

In some countries, the OHS is paid by the companies themselves, with no public support. In other countries, the OHS is partly paid by public sources. Some countries have integrated the OHS in other activities such as community health units, while other countries have OHS as separate units, with no specific association with other parts of the health system. It is difficult to say what is the best solution. What seems to be important is that the countries have legislation which requires OHS to be in place, one way or the other. Without any legislation, establishment of OHS is hard to achieve. The legislation can, for instance, ask for OHS to be established within certain industries or activities where the risk of work related diseases and injuries are high.